Effectiveness of the BALatrine intervention on soil-transmitted helminth infections in Central Java, Indonesia: a cluster-randomised controlled trial.

Abstract

Soil-transmitted helminths (STH) remain a global health challenge, particularly in areas lacking improved sanitation. We evaluated the effectiveness of an integrated BALatrine (an improved pit-latrine) intervention to prevent STH in Central Java, Indonesia. We conducted a cluster-randomized controlled trial involving 2155 participants in 8 village clusters between October 2016 and October 2017. Intervention villages received mass drug administration (MDA), the BALatrine, and community hygiene education, while the control group received only MDA. Follow-up stool samples were collected 12 months after baseline. We compared outcomes between study arms using a generalized linear mixed-effect model, with p < 0.05 considered statistically significant. At baseline, the prevalence of any STH infection was 13.0% (95% CI: 10.7-15.7) in the control group versus 12.4% (95% CI: 9.9-15.3) in the intervention group. At the follow-up, the BALatrine intervention had a significant overall effect on any STH (adjusted OR: 0.22, 95% CI: 0.15-0.32). Stratifying by species also showed a significant effectiveness of 100% for Ascaris lumbricoides and 95% for hookworm, but the reduction in Trichuris trichiura was not statistically significant. This study highlights the potential interventions that focus on sanitation and hygiene, combined with health education and treatment to control and eliminate STH. Trial registration: ACTRN12613000523707.